![]() ![]() If distance to the nearest VA provider could discourage an initial visit, as well as follow-up visits, then this study design could fail to observe true effects of health care services on suicide risk. However, this study focused on individuals who used VA services at least once, regardless of the distance to the nearest hospital. Among veterans who accessed outpatient or inpatient services during fiscal years 2003–20–2007, and controlling for sociodemographic factors and mental health diagnoses, the authors found that distance to the nearest provider was not a predictor of suicide, except among the subgroup of veterans living at extreme distances (i.e., more than 800 miles) from the nearest VA provider. Department of Veterans Affairs (VA) mental health provider. (2012) examined this relationship in the population of military veterans living at a range of distances from the nearest U.S. However, if access to mental health care is an important predictor of suicide risk, we might expect that the farther individuals have to travel to access care, the higher their risk of suicide might be. Both of these studies used cross-sectional designs, raising questions about whether the proportion of health care providers accounts for lower suicide rates or whether some other factor associated with both suicide and health care availability causes the observed associations. That study found evidence that states with higher proportions of psychiatrists, psychologists, and social workers had lower suicide rates, although these conclusions were based on bivariate analyses. ![]() A second study focused on access to care and suicide rates at the state level using data from the CDC (Thomson Healthcare, 2007). Both the density of psychiatrists and density of nonpsychiatrist physicians were associated with lower suicide rates (Tondo, Albert, and Baldessarini, 2006), controlling for sociodemographic factors (e.g., population density, proportion of men, and proportion of racial/ethnic minorities) and economic indexes (e.g., amount of federal mental health aid received by the state). Census Bureau, the Centers for Disease Control and Prevention (CDC), and the American Board of Medical Specialties, with most data collected in the early 2000s. For instance, one study examined the association between indexes of health care access-including proportion of state residents without health insurance and proportion of psychiatrists and nonpsychiatrist physicians per 100,000 residents-and rates of suicide at the state level. These studies have yielded some evidence that density of mental health providers is associated with lower suicide rates. Several studies examining the availability of health care have used state-level data on suicide rates in different regions, as well as the density of health care providers, including general practitioners, psychiatrists, and clinical psychologists. Availability of Health Care and Mental Health Services Our synthesis proceeds by examining the evidence for each of these definitions. Finally, a handful of studies has focused on more-foundational policies that may affect access to and availability of care (e.g., health insurance laws, mental health expenditures). Still others focus on the barriers to mental health care that may preclude an individual from accessing services even when they are available. Other studies focus on the use of health and mental health services by individuals who have a history of suicide ideation, suicide attempts, or a completed suicide. Several studies have defined access as the availability of health care and mental health services in a given region. The information was collected from a targeted search of the literature separate from that outlined in the methodology description.Īccess to care can be defined in many ways. Here, we synthesize the evidence on access to mental health care and its effects on suicide we find that evidence regarding the relationship between the two has been mixed. Indeed, organizations on opposite sides of gun regulation debates often agree that policies designed to improve access to mental health care offer a promising approach to reducing gun violence. Increased access to mental health services is commonly promoted as a strategy to decrease firearm violence and suicide. Nevertheless, two studies that examine mental health parity laws using more-rigorous methods for establishing causal effects suggest that such laws, and improved access to care, may reduce suicide rates. In many studies, it is not clear whether these associations are attributable to a causal effect of access to mental health care or to some other factor associated with both suicide risk and the availability of mental health care (such as urbanicity). Summary: Several studies have found an association between greater availability of mental health care and reduced rates of suicide. ![]()
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